Introduction: Limited data are available reporting the effect of proton pump inhibitors (PPIs) use on change in bone mineral density (BMD).Objective: The aim of this study was to investigate the relationship between PPI use and BMD.Methods: The current prospective analysis included 80 patients (31 males and 49 females) aged 25 to 45 years without history of hip fracture with a follow-up of at least 2 years. The study was carried out in 40 PPI users and 40 PPI nonusers. Femur and posterior-anterior spine BMD were quantified by dual-energy X-ray absorptiometry in patients who have consumed PPI at least 2 years and in nonusers PPI. The relationship between use of PPIs and BMD was tested by multivariate linear regression analysis adjusted for age, sex, BMI and several biochemical factors including serum calcium and vitamin D levels.Results: We found that there was a significant difference between the use of PPI and femoral Tscore (-0.44± 1.1 vs.0.19 ± 0.95, P=0.007) in exposed group compared with nonusers group. Multiple linear regression analysis revealed that there was noassociation between PPI use and femoral Z-score, lumbar spine T-score and Z-score between two studied groups. In addition, the frequency of femoral osteopenia and osteoporosis in exposed group was significantly more nonusers group (P=0.03).Conclusion: Overall, the results of this study showed that PPI use in patients without history of hip fracture compared with control group associated with increased risk of developing osteopenia and osteoporosis in the femur bones.

BACKGROUND Proton pump inhibitors (PPIs) are the most potent gastric agents for most acid-related disorders. Their effectiveness has led to their overutilization, leading to potential risks on patients and significant economic implications. The aim of this study was to determine the frequency of PPI overuse in Lebanon. Hence, the economic impact of this overutilization, if proven to be present, can be inferred. METHODS An epidemiological descriptive cross-sectional study was conducted in pharmacies all around Lebanese governorates over a 1-year period, using questionnaires handed out to 1000 participants coming to buy PPIs. Subjects taking PPIs for inappropriate indications or in inappropriate dosages or durations were considered abusing PPIs. PPIs are indicated for multiple gastric disorders and for prophylaxis of gastrointestinal injury when taking gastro-toxic medications. RESULTS 71. 4% of subjects were overusing PPIs. Approximately 25 million US dollars were being wasted annually. Three categories of overuse were inferred (indication, dosage, and duration). Gastro protection was the most common reason for taking PPIs. Demographic variables and doctors’ prescriptions did not influence PPI overuse. CONCLUSION PPIs are massively overused in Lebanon, leading to a huge burden on the health care system. Adhering to evidence-based guidelines and educational programs is highly recommended to enhance the quality and efficiency of prescriptions.

Background: Proton pump inhibitors (PPIs) are one of the most frequently prescribed class of drugs worldwide contributing to the increase in economic burden on the healthcare system. To study the utilization of intravenous proton-pump-inhibitors (PPIs) according to its indications, comorbidities and related pharmacoeconomics in a tertiary care teaching hospital Methods: A prospective-observational study was conducted over 3 months. Case-records of 300 indoor patients were reviewed for IV (intravenous) pantoprazole prescription, as it was the only PPI available at the hospital in IV as well as oral formulations and relevant data was procured. Results: Amongst 300 patient records, 72% were males whereas 28% were females and mean age was 41. 18 years (S. D. ±,15. 91). 37. 33% of the patients were prescribed PPIs for Stress ulcer prophylaxis and 62. 66% for non-stress ulcer prophylaxis. 62. 66% patients were prescribed IV PPIs inappropriately and 74% were found to be potential candidates for oral pantoprazole therapy without affecting patient outcomes. Utilisation of PPIs was found to be 0. 87 defined daily dose (DDD)/100 bed days. The cost of administration for intravenous pantoprazole therapy per patient per day accounted to INR 64. 34 and that for oral formulation of the same summed up to INR 1. 36. The percentage reduction in the cost of administration of PPI therapy per patient in potential candidates for oral PPI therapy was found to be 97. 8%. Antimicrobials (36%) were the most common drugs prescribed concomitantly followed by antiemetics (25%). Conclusion: Subtle changes like shifting the patient to oral formulations when clinically permissible can make a significant positive contribution in resource limited settings without negatively impacting patient outcomes. This will effectively reduce the economic burden on the patients and the healthcare system which is of utmost importance in a resource limited setting like tertiary care hospitals.

Researchers and healthcare providers can advance the field of phosphorus control, ultimately improving patient outcomes and enhancing the overall quality of care for ESKD patients.